MEDICARE: LAWRENCE AZIZA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1962395145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE AZIZA LLC

Provider Business Mailing Address
First Line	:	PO BOX 391636
Second Line	:
City	:	SOLON
State	:	OH
Zip	:	44139-8636
Country	:	US
Telephone Number	:	234-400-4999
Fax Number	:

Provider Business Practice Location Address
First Line	:	1893 WYMORE AVE
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-3913
Country	:	US
Telephone Number	:	234-400-4999
Fax Number	:

Authorized Official
Title or Position	:	ACCOUNTANT
Name	:	ERIC B HALES
Credential	:	BS BUSINESS ADMIN
Telephone Number	:	216-276-5482

Provider Enumeration Date	:	05/29/2025
Last Update Date	:	05/29/2025

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